Date of filing: 30.09.2019 Date of disposal: 06.07.2022 BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BENGALURU (PRINCIPAL BENCH)

DATED: 06.07.2022 PRESENT Mr.K.B SANGANNANAVAR : JUDICIAL MEMBER Mrs. DIVYASHREE M : LADY MEMBER APPEAL NO.1411/2019 Sri.V. Rama Rao, S/o Venkatanarasappa, Aged about 80 years, Managing Director, M.C.C.W Ltd., K.M Road, Chikmagalur – 577 101. …..Appellant/s (Advocate – Sri.Shiv Kumar)

V/s M/s. New India Assurance Company, Panduranga Complex, K.T Street, Chikmagalur – 577 101.

Represented by its Manager. …..Respondent/s (Advocate – Sri.P.S Jagadish)

ORDER

Mr.K.B SANGANNANAVAR, JUDICIAL MEMBER This is an Appeal filed by the complainant in Complaint No.51/2018 on the file of Chickmagalur District Consumer Disputes Redressal Forum, aggrieved by the order dated 30th August 2019.

2. The brief facts of the case of the complainant before the Forum below, he had availed a Medi-claim policy from OP in the year 1978 for a sum assured of Rs.3,00,000/-. He has been paying an annual premium regularly and his policy was valid till 08.09.2017 and he was suffering from prostate and Hernia problems, was admitted to Apollo Hospital, Jayangar, Bangalore on 13.06.2017 and was operated upon on the same day. Based on the recovery, he was discharged on 16.06.2017. He incurred a total sum of Rs.3,58,384/- for his surgery. M/s.Medi Assist Insurance TPA Pvt. Ltd., paid an amount of Rs.1,23,971/- as against Rs.3,58,384/- claimed by him. OP failed to pay Rs.2,34,230/-, he raised consumer complaint. OP contested the complaint and the Forum below held an enquiry on the basis of affidavit evidence of parties, Ex.P-1 to 14 and Ex.R-1 & 2 respectively and thereby found as complainant has admitted in reply given by him to the interrogatories filed by OP that he has studied the terms and conditions of the new Medi-claim 2012 policy issued in his favour which cannot be said he had not noticed the terms and conditions of the new policy 2012 issued in his favour thereby dismissed his complaint, which is now in this Appeal on the ground Forum below erred in relying Ex.R-2 and failed to perceive the materials on record. The Forum below could have appreciated interrogatories and reply thereon conjointly and not in isolation and the impugned order is contrary to the facts and law is liable to be set aside.

3. The Commission heard learned counsel for Appellant and Respondent. We have also examined the impugned order and grounds of Appeal and now to decide on this appeal.

4. It is not in dispute that, complainant had availed Medi-

claim policy in the year 1978 for a sum assured of Rs.3,00,000/- and he has been paying an annual premium regularly and his policy was valid till 08.09.2018. As on the date of complaint, he was aged about 80 years. Learned counsel submits that, now he is aged about 84 years, had incurred Rs.3,58,384/- towards treatment for his prostate and hernia problems with Apollo Hospital, Bangalore and as against his claim of Rs.3,58,384/-, OP paid Rs.1,23,971/- assessed by M/s.Med Assist TPA Private Limited., and submits that complainant at this advance stage having been availed service of OP since 1978 paying premium regularly was denied Rs.2,34,413/-, since sum assured was Rs.3,00,000/-. On the contrary learned counsel for insurer submits that, Forum below has rightly appreciated the interrogatories delivered by the OP to the complainant, since complainant has admitted studying of the terms and conditions of the new Mediclaim 2012 policy issued in his name.

5. Let us examine materials on record and interrogatories delivered by the OP to the complainant as well as answered thereon of complainant. Ex.P-1 is a policy schedule issued in the name of complainant for the period from 09.09.2017 to 08.09.2018. Insured persons are Mr.V.Rama Rao and Smt.H.Lalitha R Rao, they are husband and wife. We could also find name of TPA for OP who is Medi Assist Insurance TPA Pvt. Ltd. We as admittedly settled the claim of complainan